Xiong Xin, Li Lei, Feng Yu-Xing, Liu Shuai, Zhao Chao, Gao Long, Li Jin-Yu, Feng Dui-Ping
Academy of Medical Sciences, Shanxi Medical University.
Department of Oncological and Vascular Intervention, First Hospital of Shanxi Medical University.
Eur J Gastroenterol Hepatol. 2025 May 1;37(5):668-674. doi: 10.1097/MEG.0000000000002942. Epub 2025 Mar 5.
The incidence of hepatic encephalopathy (HE) was higher within 1 year after transjugular intrahepatic portosystemic shunt (TIPS) in cirrhosis. While some findings showed that the shunt flow correlates with HE, it remains unknown whether the stent shunt flow (SSF) is associated with overt-hepatic encephalopathy (OHE). This study, therefore, investigated the association between SSF and OHE after a TIPS.
A digital color ultrasonic diagnostic device was used to measure stent flow velocity (SFV). The association between SSF and OHE was then examined using logistic regression and restricted cubic spline models. The predictive value of SSF for OHE was also assessed using receiver operating characteristic curve analysis.
Of the 91 patients, 24 (26.4%) developed OHE after TIPS within 1 year. Patients with OHE post-TIPS had higher SSF than those without [2459 (2203-2490) ml/min vs. 2190 (1968-2363) ml/min; P = 0.001]. Multiple logistic regression showed interquartile range of SSF was associated positively with the risk of OHE after TIPS [odds ratio, 2.483; 95% confidence interval (CI), 1.407-4.383; P = 0.002]. The Andersen-Gill model indicated SSF [hazard ratio (HR), 1.002; 95% CI, 1.001-1.004; P < 0.05] and age (HR, 1.042; 95% CI, 1.012-1.072; P < 0.01) were independent predictors of OHE after TIPS. SSF had higher predictive power for OHE than age, ammonia levels, Child-Pugh score, and model for end-stage liver disease score.
This study suggests high SSF may be associated closely with an increased risk of OHE in patients with cirrhosis following TIPS.
肝硬化患者经颈静脉肝内门体分流术（TIPS）后1年内肝性脑病（HE）的发生率较高。虽然一些研究结果表明分流流量与HE相关，但支架分流流量（SSF）是否与显性肝性脑病（OHE）相关仍不清楚。因此，本研究调查了TIPS术后SSF与OHE之间的关联。
使用数字彩色超声诊断设备测量支架流速（SFV）。然后使用逻辑回归和受限立方样条模型检查SSF与OHE之间的关联。还使用受试者工作特征曲线分析评估SSF对OHE的预测价值。
91例患者中，24例（26.4%）在TIPS术后1年内发生OHE。TIPS术后发生OHE的患者的SSF高于未发生OHE的患者[2459（2203 - 2490）ml/分钟对2190（1968 - 2363）ml/分钟；P = 0.001]。多因素逻辑回归显示，SSF的四分位数间距与TIPS术后OHE的风险呈正相关[比值比，2.483；95%置信区间（CI），1.407 - 4.383；P = 0.002]。Andersen - Gill模型表明，SSF[风险比（HR），1.002；95%CI，1.001 - 1.004；P < 0.05]和年龄（HR，1.042；95%CI，1.012 - 1.072；P < 0.01）是TIPS术后OHE的独立预测因素。SSF对OHE的预测能力高于年龄、氨水平、Child - Pugh评分和终末期肝病模型评分。
本研究表明，高SSF可能与肝硬化患者TIPS术后OHE风险增加密切相关。
